Objective To investigate the spiral CT manifestations of the collateral circulation pathways resulting from splenic vein occlusion (SVO) duo to pancreatic diseases. Methods The CT imaging and clinical data of 33 cases of pancreatic disease with SVO, including 28 cases of pancreatic carcinoma, 3 cases of acute pancreatitis and 2 cases of chronic pancreatitis, were retrospectively analyzed.Results Tortuous and dilated vessels were observed in the areas between splenic hilum and gastric fundus and/or along the gastric greater curvature in all 33 cases. In isolated SVO cases, the short gastric vein (SGV, 86%)，coronary vein (CV, 79%)，gastroepiploic vein (GEV, 79%) and gastrocolic trunk (GCT, 57%) were varicose and dilated. While in nonisolated SVO，other collateral veins such as the right superior colic vein (RSCV, 37%），middle colic vein (MCV, 37%） and posterior superior pancreaticoduodenal vein (PSPDV, 21%） were seen as well. Conclusion The two predominant collateral pathways of SVO are ①SGV→gastric fundal veins→CV， and ②GEV→GCT→SMV. They have characteristic imaging features on spiral CT and are of clinical significance in both preoperative staging of pancreatic carcinoma and the evaluation of pancreatogenic segmental portal hypertension.
To survey the penetrance of Nimodipine to blood-pancreatic barrier. Pancreatic fluid of 15 cases with pancreatic diseases were respectively sampled from pancreatic drainage tubes at different time after Nimodipine taken orally, and the concentrations of Nimodipine in the fluid were measured with high performance liquid chromatography (HPLC). The average concentration of Nimodipine in pancreatic fluid at 0.5,1,1.5,2,2.5,3,3.5,4 hours after Nimodipine administration were 4.79,7.31,9.21,8.04,6.05,5.11,3.37 and 1.19 ng/ml, respectively. The highest value of Nimodipine level in pancreatic fluid were 9.21 ng/ml at 1.5 to 2 hours following Nimodipine taken orally. These suggested that the Nimodipine can penetrate across the bloodpancreatic barrier and make its pharmacolohical effect in pancreatic tissue.
Objective To explore the clinical value of laparoscopy in the treatment of pancreatic diseases. Methods Twelve patients with pancreatic diseases received laparoscopic surgery. Among which 9 patients with cystic diseases, 4 cases underwent laparoscopic spleen-preserving distal pancreatectomy, 2 cases received distal pancreatectomy and splenectomy, and 3 cases underwent pancreatic cystectomy. Laparoscopic insulinoma enucleation was performed for 2 patients who suffered from insulinoma. Besides, a patient suffered from pancreatic carcinoma recurrence received left thoracoscopic splanchnicectomy. Results All the operations were accomplished successfully, including 8 total laparoscopic surgery and 4 laparoscopic assisted surgery. The average operative time was 225 min （range 100-420 min）, and the average volume of blood loss was 80 ml （range 2-150 ml）. Pancreatic fistula was observed in 1 patient which was cured by conservative therapy. The postoperative average hospital stay was 7.2 d （range 5-13 d）. The patient with recurrent pancreatic carcinoma survived for 6 months after operation and the pain-killing effect was satisfactory. With a follow-up of 10-36 months for other patients, the surgical effects were ideal and no recurrence occurred.Conclusion With the advantages of less trauma， less pain， fast recovery， and low morbidity rate, laparoscopic surgery is an effective and safe method for the treatment of pancreatic diseases, and thus may be widely used in the clinical settings in the future.
ObjectiveTo investigate the clinical characteristics of pancreatitis, panniculitis, and polyarthritis syndrome (PPP syndrome). MethodsA patient with PPP syndrome in July 2013 was reported. The clinical features of 33 cases of PPP syndrome at home and abroad were reviewed. ResultsOur patient with panniculitis and arthritis as the first manifestation had few abdominal symptoms despite high serum levels of pancreatic enzymes. In the 34 PPP cases, 70.6% (24/34) had absent or mild abdominal symptoms, easily leading to misdiagnosis. Multi-joint involvement was more common, and in almost 1/3 of the patients, joint symptoms with poor NSAIDs and/or hormonal responses predated the identification of pancreatic disease. Panniculitis biopsy found characteristic "ghost cells". Ten patients died of complications of pancreatic disease (including 2 cases of cancer), and the mortality rate was as high as 29.4% (10/34). ConclusionPPP syndrome with mild abdominal symptoms and high mortality should be taken for the treatment of pancreatic disease, to prevent misdiagnosis and mistreatment.